Research Awards Recipients

General Audience Summary

The decision to start long-term dialysis in patients with advanced chronic kidney disease (CKD) is based on many factors including the degree of kidney dysfunction, bloodwork (e.g. potassium and acid levels), fluid status, and symptoms related to the buildup of toxins normally cleared by the kidney (i.e. uremic toxins). How starting dialysis affects the presence and severity of symptoms attributed to uremic toxins such as fatigue, itchiness, restless legs and mood is unknown. The objective of this study is to determine how these individual uremic symptoms respond to the initiation of dialysis in patients with advanced CKD. Procedure: 150 patients with advanced CKD that are at high risk of needing dialysis followed in multidisciplinary CKD clinics (i.e. clinics with a team of healthcare professionals made up of nurses, dieticians, pharmacists and doctors) across Canada will be followed over 2 years. Their symptoms before and after starting dialysis will be collected over time using questionnaires to determine which symptoms improve, worsen or do not change over time. A subset of patients will also have their blood collected and analyzed to determine which uremic toxins are associated with each symptom using technology that separates molecules in fluids by size and charge in order to accurately identify and measure them. Outcome: This results of this study will inform whether or not specific symptoms common in patients with advanced CKD improve following the initiation of dialysis. It will also identify the uremic toxins associated with symptoms in order to better understand their development and potentially identify new targets for treatments. Relevance to patients: Symptoms are common in patients with advanced CKD including fatigue (70%), itchiness (50%), restless legs (30%) and depression/anxiety (30%). Initiating dialysis is frequently used to help with these symptoms because other treatments are not typically effective. However, whether or not initiating dialysis improves specific symptoms and to what degree is unknown. The results of this study will help patients and their kidney doctors decide on whether or not to start dialysis for their symptoms of not. If patients have many symptoms that are known to improve with dialysis, they may choose to start dialysis earlier and if their symptoms are not affected by dialysis, they may choose to defer it with consideration of its known risks.